Mental Healthcare
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Item Performance Audit on Mental Healthcare in Gujarat(CAG of India, 25-09-2020) CAG of IndiaAudit conducted (April-November 2019) a review of mental healthcare in the State (Gujarat) to assess and evaluate efficacy of mental healthcare services and rehabilitation of mentally ill persons. Records pertaining to the period 2015-19 maintained at the office of State Mental Health Authority, all four HMHs58, six GMCs59 and 11 of 33 DMHP units60 were scrutinised by Audit. Selection of DMHP units was done by adopting Simple Random Sampling Without Replacement method. The MH Act 1987, Minium Standards of Care in Mental Hospitals prescribed by National Institute of Mental Health and Neuro Science (NIMHANS), Bengaluru, Guidelines of District Mental Health Programme issued by GoI and instructions issued by SMHA were adopted as criteria for evaluation. After the performance audit, CAG of India arrived at the following conclusion: As per National Mental Health Survey (2015-16), 7.40 per cent of total population above 13 years age in Gujarat are suffering from one or more mental disorders. The suicide incidence rate per lakh population was found on higher side in Gujarat (11.70) than at National level (10.60). Audit observed gaps in policies, plan and executive response as (i) State Mental health policy drafted in 2009 was not approved as of May 2020, (ii) Action plan for specified activities was not prepared, (iii) only 0.50 per cent of State health budget was allocated for mental health services and (iv) The Mental Healthcare Act, 2017, enacted by GoI, to provide mental healthcare and services and to protect, promote and fulfil the rights of person with mental illness was not implemented as of May 2020. Objectives of District Mental Health Programme (DMHP) for prevention of mental illness and promotion of mental healthcare services remained under-achieved due to deficiencies in planning, execution of awareness campaign and targeted intervention. Acute shortage of mental health professionals were noticed in all four Hospitals for Mental Health and DMHP units. Schemes for development of manpower and training programme for early diagnosis and management of mental illness could not yield desired results due to lack of efficient planning and execution. As a result, mental healthcare could not be integrated with primary healthcare at the level of PHCs and was partially integrated at the level of CHCs. Indoor services were not available in two test-checked DMHP units due to non-availability of Psychiatrist and separate wards. Protocol developed for social, psychological, clinical and psychiatric treatment was partially followed in HMHs except HMH, Ahmedabad. Government had not established rehabilitation centre for rehabilitation of mentally ill people. In absence of rehabilitation centre, 131 patients fit to be discharged for one to five years are languishing in Hospitals for mental health. Functioning of occupational therapy unit was found appreciable in HMHs of Ahmedabad and Vadodara but deficient in HMHs of Bhuj and Jamnagar. Establishment of Aadhaar helpline service for rescue and treatment of wandering patients and Dava and Dua concept to provide formal/institutional psychiatric treatment alongside traditional faith healing were found appreciable in Audit.